Percheron artery territory infarct

Case contributed by Dr Akos Jaray


Found on floor. Unequal pupils in A&E. CT head showed left thalamic lacunar infarct. No upward or downward gaze, ataxia, reduced GCS.

Patient Data

Age: 70 years
Gender: Male

The symmetrical areas of restricted diffusion and hyperintense appearance on FLAIR images denote bilateral paramedian thalamic and midbrain infarctions.


Previous non-contrast CT demonstrates left thalamic infarction. The rest of the infarcted areas can only be suspected retrospectively.

Case Discussion

The pathognomonic appearance of this special type posterior circulation infarction can be explained by the presence of congenital variant of artery of Percheron.

The findings are best seen on FLAIR and DWI sequences, while CT might miss or underestimate the infarct. The V-shaped hyperintensity due to midbrain infarct is congruent with the ataxia and oculomotor symptoms.

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Case information

rID: 72394
Published: 23rd Nov 2019
Last edited: 26th Jan 2020
Inclusion in quiz mode: Included
Institution: University of Pécs

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